[1]张科,吴奇勇*邹志清①,吴周全①.非气管插管麻醉下单孔胸腔镜治疗自发性气胸的临床应用[J].中国微创外科杂志,2017,17(12):1068-1070.
　Zhang Ke*,Wu Qiyong*,Zou Zhiqing,et al.Application of Uniportal Thoracoscopic Bullectomy in the Treatment of Spontaneous Pneumothorax Under Non-intubated Anesthesia[J].Chinese Journal of Minimally Invasive Surgery,2017,17(12):1068-1070.
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非气管插管麻醉下单孔胸腔镜治疗自发性气胸的临床应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年12期
页码:
1068-1070
栏目:
临床研究
出版日期:
2017-12-20

文章信息/Info

Title:
Application of Uniportal Thoracoscopic Bullectomy in the Treatment of Spontaneous Pneumothorax Under Non-intubated Anesthesia
作者:
张科; 吴奇勇*邹志清①; 吴周全①
南京医科大学附属常州第二人民医院心胸外科，常州213003
Author(s):
Zhang Ke*;  Wu Qiyong*;  Zou Zhiqing;  et al.
*Department of Cardiothoracic Surgery, Changzhou Second People’s Hospital of Nanjing Medical College, Changzhou 213003, China
关键词:
非气管插管麻醉;  单孔胸腔镜;  自发性气胸
Keywords:
Non-intubated anesthesia; Uniportal thoracoscopy; Spontaneous pneumothorax
文献标志码:
A
摘要:
目的探讨非气管插管麻醉下单孔胸腔镜肺大疱切除术治疗自发性气胸的可行性。方法2015年1月~2017年2月，对40例自发性气胸行不插管静脉全麻复合椎旁神经阻滞下单孔胸腔镜肺大疱切除术。行T4~T5水平椎旁神经阻滞麻醉，舒芬太尼、丙泊酚诱导，意识消失后面罩呼吸机辅助通气，术中用右美托咪定、丙泊酚和瑞芬太尼靶控输注镇静镇痛，行单孔胸腔镜肺大疱切除术。结果40例均顺利完成手术，无中转气管插管全麻。麻醉时间、麻醉苏醒时间以及在手术室的总时间分别为（24.0±5.0）min、（15.0±10.0）min和（71.0±25.5）min；手术时间（31.0±10.0）min。术中血气分析PaCO2（45.0±5.0）mm Hg，术后12小时血气分析PaCO2（40.0±6.0）mm Hg。术后胸腔闭式引流管留置时间（1.5±0.5）d，术后住院时间（2.0±1.0）d。无术中大出血、术后出血二次手术。术后漏气1例，负压吸引保守治疗治愈。术后随访（12±4）月，无气胸复发。结论单孔胸腔镜手术治疗气胸可以在非气管插管麻醉下完成，创伤小，尤其对气管插管有高危因素者，但需要麻醉师和术者完美配合，手术技能培训尤为重要。
Abstract:
ObjectiveTo investigate the feasibility of uniportal thoracoscopic bullectomy in the treatment of spontaneous pneumothorax under non-intubated anesthesia.MethodsA total of 40 patients with spontaneous pneumothorax underwent uniportal thoracoscopic bullectomy under non-intubated anesthesia combined with paravertebral nerve block. The level T4-T5 local anaesthetic block was performed. After the induction with sufentanil and propofol, patients were preserved spontaneous ventilaiton by mask oxygen-inspiration. The bullectomy was accomplished with target controlled infusion of dexmedetomidine, propofol and remifentanil.ResultsThe operation was completed successfully in all the 40 patients, without conversion to endotracheal intubation general anesthesia. The duration of anesthesia, time of resuscitation, and total time in the operating room were (24.0±5.0) min, (15.0±10.0) min, and (71.0±25.5) min, respectively. The operation time were (31.0±10.0) min. Intraoperative blood gas analysis showed PaCO2 was (45.0±5.0) mm Hg, and 12 hours postoperative blood gas analysis showed PaCO2 was (40.0±6.0) mm Hg. The retained time of thoracic drainage tube was (1.5±0.5) days. The hospital stay after operation was (2.0±1.0) days. No intraoperative hemorrhage or postoperative hemorrhage occurred. Air leakage was found in 1 case, and was improved after conservative treatment. There was no pneumothorax recurrence in follow-ups for (12±4) months.ConclusionsThe uniportal thoracoscopic surgery for pneumothorax can be accomplished under non-intubated anesthesia, especially for patients with high risk factors for tracheal intubation. The surgery requires perfect coordination between anesthesiologists and surgeons. Surgical skills training is particularly important.

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备注/Memo

备注/Memo:
*通讯作者，E-mail：wqyxycxy@aliyun.com①麻醉科
更新日期/Last Update: 2018-03-21